title: Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr.
abstract: BACKGROUND
  Mild hypoglycemia is commonly observed in children treated for type 1 diabetes mellitus (T1DM). Hypoglycemia disturbs cognition and learning.
  
  
  OBJECTIVE
  To describe how and to what extent hypoglycemia in young children with T1DM is detected in everyday life. To learn how parents and caregivers treat hypoglycemia and to evaluate how efficient this treatment is.
  
  
  METHODS
  Twenty-three children [12 girls, mean age: 4.5 yr, mean HbA1c: 59 mmol/mol (7.5%)], 17 of whom were treated with an insulin pump, underwent blinded continuous glucose monitoring (CGM). Data on symptoms and treatment of hypoglycemia were collected in a logbook. Plasma glucose values were collected through self-monitoring of blood glucose and entered in the logbook, and glucometer memories were uploaded. Data were collected during 1 wk in autumn and 1 wk in spring.
  
  
  RESULTS
  Only 32% of all hypoglycemic events were detected despite plasma glucose being checked 10 times per day. Most hypoglycemic events were asymptomatic (90% overall and 98% of those occurring at night). Untreated hypoglycemic events were associated with a relapse into hypoglycemia within 3 h in the majority of events. Compared to treatment of hypoglycemia events with a defined dose of simple carbohydrates, treatment with a mixed meal resulted in a significantly higher glucose value 1 and 2 h after the hypoglycemia.
  
  
  CONCLUSIONS
  For optimum treatment, children younger than 7 yr with T1DM need better strategies and support for detecting hypoglycemia with real-time CGM. Hypoglycemia should be treated with a defined dose of carbohydrates rather than a mixed meal.
authors.affiliation: Diabetes Unit, Department of Pediatrics, Sahlgrenska Academy, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, SE 41685, Gothenburg, Sweden.
authors.forename: Frida
authors.initials: F
authors.lastname: Sundberg
authors.forename: Gun
authors.initials: G
authors.lastname: Forsander
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000178:diet therapy / Q000628:therapy; D008297:Male; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: CGM; T1DM; hypoglycemia; pre-school children; self-monitored plasma glucose